Exploring socio-cultural factors that influence maternal mortality and perceived strategies for its reduction in south eastern Nigeria

Background: The risk of a woman dying from avoidable complications during pregnancy and childbirth has declined significantly in high income-countries but has remained unacceptably high in most of the middle- and low-income countries. In Nigeria, pregnancy and childbirth have continued to represent a period of sorrow and tragedy for several families. For instance, a woman in Nigeria is more than 200 times per pregnancy and childbirth more likely to die than a woman from other middle or low-income countries. To-date, previous studies indicate a dearth of information regarding the socio-cultural factors that contribute to maternal mortality in Nigeria. Methodology: This qualitative study aimed to explore and describe the perceived socio-cultural factors impacting on maternal mortality and strategies for its reduction in South-Eastern Nigeria. Data was collected using focus group discussions involving 10 women with children and 10 women without children. Individual interviews were also conducted involving another 19 participants. These comprised women of reproductive age who did not participate in the focus group discussion, doctors, midwives, traditional birth attendants, a village head, a religious leader, a youth leader, and a women’s leader.The findings: show a dominant discourse of culturally based perceptions of deep-rooted cultural and religious belief systems. Most of the community members constructed a system of beliefs about pregnancy, childbirth, and maternal mortality, which shaped decision-making regarding the uptake of maternal services. However, a dichotomy existed amongst the professionals about the use of either culturally based worldviews or biomedical knowledge to inform practice. These culturally grounded perceptions were facilitated by the deliberate or unintentional actions of people in government impacting their lack of will to formulate policies and provide resources that would encourage women to utilise maternity services, as well as motivate professionals to deliver effective maternal health services. This thesis also uncovered knowledge beyond cultural meaning-making and revealed that social complexities, such as economic status, the attitude of the healthcare workers and social networks, were issues contributing to the low uptake of maternity services and potentially the high rate of maternal deaths. Specifically, it was found that the poor economic status of some pregnant women, the unfriendly attitude of healthcare professionals, and negative advice from members of their social networks influenced women’s maternity healthcare-seeking behaviour, thereby potentially increasing maternal deaths. Overall, findings revealed that women’s behaviour, which might have contributed to the high maternal death rate, stemmed from cultural, social, and contextual factors. Lastly, perceived strategies for the reduction in maternal deaths, such as free-maternal healthcare services, the assimilation of TBAs into hospital-based midwifery practice and culturally sensitive services, were found in this study and could be used by policy makers to improve maternal wellbeing, ensuring maternity services meet the needs of women and families. Conclusion: The findings suggest the need for cultural shifts in meaning-making and attitude to promote maternal wellbeing. This study contributed to knowledge in this field and can be used to enhance culturally sensitive maternal care, as well as knowledge that is relevant for policy intervention, ensuring pregnancy and childbirth is safer